Provider Demographics
NPI:1710930284
Name:ALZATE ARROYAVE, RONALD FERNANDO (PT)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:FERNANDO
Last Name:ALZATE ARROYAVE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 81ST ST APT 4K
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-5071
Mailing Address - Country:US
Mailing Address - Phone:917-806-8610
Mailing Address - Fax:
Practice Address - Street 1:3521 81ST ST APT 4K
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-5071
Practice Address - Country:US
Practice Address - Phone:917-806-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ32V2Q4FH1OtherMEDICARE PTAN